When you mention endometriosis, you almost automatically think of pain. That dysmenorrhea that a specialist in this condition places on your VAS (Visual Analogue Scale) scale from 1 to 10. And yes, many cases of endometriosis and/or adenomyosis can easily reach the threshold of 10 units. Although many patients with advanced stages of endometriosis do not complain of pain at all, there are still many others who experience severe chronic pain. Most experience dysmenorrhea in the pelvis and during sexual intercourse. A significant percentage also report back pain, which under certain conditions can radiate along the spine or even down one of the lower limbs.
According to some theories, the causes of endometriosis are attributed to the abnormal growth of endometrial tissue outside the uterus and its migration to other parts of the body. The result? Cysts, scar tissue, nodules, adhesions. And these are the main causes of pain.
In some cases, migrating endometrial tissue may be found in the lower part of the spinal canal (lumbar area) or in the vicinity of the vertebrae. The pain can radiate along the back if the endometrial implants enclose the nerves or are found in their path.
As for treatment options, hormone therapy and pain therapy are currently favored. Hormone therapy targets hormones involved in fertility and childbirth, aiming to inhibit their role, without which endometrial cells cannot proliferate, regardless of their location. For obvious reasons, these treatments should be avoided during pregnancy or when pregnancy is desired.
Surgery targeting back pain caused by endometriosis is an invasive and risky method because it involves an operation on the spinal cord, which is much more complicated than those performed in the pelvic region. However, if back pain or neurological symptoms persist and cannot be treated by other methods, surgery for pain therapy may be considered. In this case, it is especially important to discuss with your doctor any possible risks, costs, and the likelihood of recurrence of pain.
Regarding minimally invasive procedures for chronic back pain, the following are currently used:
- Radiofrequency ablation: This procedure uses electricity or radio waves to generate heat at the painful site, blocking the passage of pain signals through the nerve. The nerves remain inactive for up to 18 months, after which the procedure can be repeated.
- Epiduroscopy: This involves inserting a catheter with a video camera attached through which the doctor can explore the epidural space. The procedure is performed with local anesthesia in the coccyx, allowing the doctor to identify adhesions, fibrosis, and possible scars affecting the nerves. Once identified, they can be removed, and the doctor can inject a steroid that has a significant effect on pain over time.
- Infiltrations: Inflammations of the spinal nerves can be treated by injecting a mixture of steroids, local anesthetic, and saline solution where the nerve leaves the spine. Once inflammation is reduced, pain can diminish or disappear.
Peripheral nerve blocks are another minimally invasive procedure that can be helpful in back pain and pelvic pain. This involves injecting an anesthetic into the nerve plexuses or nerve cells that transmit pain.
These are some ways to approach severe chronic back pain caused by endometriosis. However, regardless of your pain threshold on the VAS scale, such procedures should only be performed on the recommendation of a doctor following thorough investigations recommended by the specialist.
Sources: images.medicinenet.com